News

In the seemingly endless newsfeed to which so many of us find ourselves exposed, becoming sufficiently hardened to the onslaught of shockingly bad news appears to be a method of self-preservation. However, sometimes the bad news is so heartbreaking, so gut-wrenching, so unconscionable, that the air you breathe seems literally stolen from you.

That is what happened to me last week when I learned of an eight-year-old Yemeni girl who was forced to marry a forty-year-old man. If that were not awful enough, the young girl died of internal bleeding and uterine rupture on her wedding night.

Most of us in the West almost don’t possess the parameters within which to process such news, much less accept it.

The Republic of Yemen, the poorest country in the Middle East, has a relatively recent genesis. In 1990, the traditional North and Communist South merged after years of clashes. Modernization attempts have been slow at best, and the country still retains much of its tribal character. The intervening years since the unified country’s birth have seen a civil war in 1994 that left 250,000 dead, and in 2011, protests inspired by the Arab Spring ultimately resulted in the resignation of President Ali Abdullah Saleh, a man who had run North Yemen, and then the unified country, for a total of thirty years. Following the closure of their bases in Pakistan and Afghanistan, Al Qaeda filtered into Yemen, and it became a major Al Qaeda stronghold.

Yemen also has the highest illiteracy rate in the region. The literacy rate for women is approximately 40 percent, compared to 70 percent for men. This gap is explained by traditional views on female education, which is thought at best to be inconsequential, and at worst to be in direct opposition to a girl’s good morals.

Poverty, tribal warfare, political instability, illiteracy. A veritable guaranteed recipe for disaster of the type to which we have just borne witness.

Human Rights Watch reports that 14 percent of Yemeni girls are married before the age of fifteen; however, the Social Affairs Ministry in 2010 reported that number to be 25 percent. Although Yemen passed a law in 2009 making it illegal for girls under seventeen to marry, the law was ultimately repealed after conservatives said it went against the teachings of Islam.

Is it the teachings of Islam against which the Minimum Age Law went? Or was it patriarchal and impoverished rural families’ inability to resist “bride prices” for their daughters that caused the law’s repeal?

For the eight-year-old Yemeni girl named Rawan, the reason (I simply cannot type the word rationale in this context) behind the law’s repeal matters not a damn. She was sold by her parents and now she is dead; killed by her purchaser in, without a doubt, the worst possible way. It is utterly impossible to try to imagine what her last thoughts were — or perhaps even her first, once her little eight-year-old mind began to grasp the truth of the awful, amoral transaction to which her parents had subjected her.

To add insult to injury, Yemen security officials deny the incident took place.

While we would especially like to in cases like this, we cannot legislate morality outside our borders. And although the EU foreign policy chief demanded that Yemen ban child marriage and reinstate the repealed Minimum Age Law in keeping with international norms, in all likelihood it will not happen anytime soon. Certainly we will hear of another child like Rawan dying a horrible and senseless death.

Simply put, only when a society values its girls to the same extent as it does its boys will this hideous type of child abuse finally commence its long-overdue dark ride into the annals of ancient history.

On August 20, 2013, I posted an article entitled “What’s in a name?” about the Baby Messiah case in Tennessee in which a bench officer unilaterally changed a toddler’s first name in a family law case involving determination of paternity and child support. The bench officer stated that she based her decision to change the toddler’s name from Messiah to Martin as Tennessee had so many Christians, and many people in the state she believed would be offended by the toddler’s given name.

My article received many comments from readers, the overwhelming majority of whom agreed that a sitting bench officer had no business changing a child’s given name, especially on religious grounds. There was one reader (an eighth-decade Episcopalian minister turned evangelical) who wrote that while he “was preparing [himself] to be offended by [my] article, he thought it was well written.” Which I took to be a sort of backhanded compliment offered, to my relief, without his religious views or objections on the matter.

After reviewing the mail on the issue and upon further reflection, I realized perhaps even more than before just how important our given names are to our sense of self in general and our sense of identity in particular — perhaps even more important than our surnames, which are handed down without much agency or deliberation.

Our surnames are bestowed upon us by ethnic background or region, and historically, by the professions of our forbears (Shoemaker, Blacksmith, Kaufman [meaning trader], Cohen [indicating one from the rabbinical caste], etc.) However, our given names clearly represent choices, those of our parents. They thus represent a far more important element of familial desire and identity than our surnames, and are often selected based on the popular first names du jour, on some special family meaning, in memory of a deceased loved one, or on a myriad of other modern-day and often odd choices (Gwyneth Paltrow’s daughter Apple, anyone?)

Throughout all but the most recent history of immigration to the United States, many given names were changed upon arrival at Ellis Island by lazy or bigoted entry officers, following perhaps the same rationale expounded by the Tennessee bench officer in the Baby Messiah case. My paternal grandfather, for example, arrived at Ellis Island with his wife and three teenaged children in the midst of WWII. His first name was Ignatz, at the time a fairly common Austro-Germanic given name. However, the immigration officer on duty that day at Ellis Island simply didn’t like his first name or couldn’t pronounce or spell it, and thus my grandfather, a Holocaust survivor who arrived stateless in the U.S. and had already lost so much, had then also lost his first name that day with the brisk stroke of a careless man’s pen. My grandfather thus unceremoniously became Nat, and he kept that name for the rest of his very long and abundantly happy life. In retrospect (and my grandfather never once complained about the name change — he often just rehashed the story as part of family lore), it seems an extremely small price to pay: losing one’s given name in exchange for the chance of entry into a hospitable country and a good life while ethnic annihilation is happening elsewhere. But that’s not really the point.

The point is choice. It is always about choice in a democracy. As a law professor friend of mine says repeatedly in her Constitutional law classes, “Democracy without freedom is like two wolves asking a sheep, What’s for lunch?”

It is also the freedom to make a bad choice. And this is true even in the commercial sector. I recall many moons ago when Chevrolet began marketing a midsize car called the Nova. That was just fine for the US market. However, Chevrolet then started exporting it south of the border. That, Chevrolet quickly learned, was a huge problem, as “no va” in Spanish means “it doesn’t go.” Not your best bet for a motor vehicle. And then there was the Korean restaurant my husband and I loved mainly because it was the site of our first date. We returned there regularly out of a sense of nostalgia and the need for fiery bulgogi and burning kimchi. Years later, the restaurant changed hands and the new owner changed the decor. He also had the brilliant idea to rename the restaurant. When I drove by one day a few months later, I could hardly believe my eyes. In a city that hosts an enormous and vibrant Latino population, the new owner chose the name Moku, which in Spanish means, to be anatomically correct, nasal detritus. Predictably, the restaurant closed shortly thereafter.

The freedom to keep one’s given name and bestow names upon our children seems so obvious that the discussion almost seems absurd. But clearly it is a discussion that must take place, as a judicial maverick, under color of authority and a sense of religious self-righteousness, has purported, however misguidedly, to have a legal basis on which to alter this most basic freedom of parental choice and identity. Personally, I would never name a son of mine Messiah, chiefly because I don’t share the religious connection, and from a more pragmatic perspective, I would fear that as he grew up his friends would call him Messy or Mess for short. Nevertheless, I hope Baby Messiah’s mother’s appeal in Tennessee to unload the name Martin will be successful in short order. Because what’s in a name is a fundamental personal choice — the choice to bestow it, to keep it, or to change it.

When I think of life’s greatest moments of vulnerability, I think of birth (as in giving it), death (though since I still possess a beating pulse I have no true empirical evidence on that event), and being unconscious — as when one is under general anesthesia in an operating room setting.

Those extremely vulnerable moments in life force the vast majority of us in the West to rely completely on physicians. We rely on them to keep us comfortable, safe, and, at least with regard to childbirth and surgery, to help us come out on the other side of the event with our dignity and honor intact, and hopefully also with a healthy child and without whatever it was that required the surgery in the first place.

There is of course the “normal” anxiety that one has when facing these challenges. For example, will one’s pre-authorized insurance ultimately cover the procedure when the claim is finally submitted? Will there be any complications from the birth or the surgery or the anesthesia? And will all the people in the operating room remember exactly why they are there and what to do and operate on the correct body part, and also remember not to leave anything behind in the surgical site, such as sponges, instruments, etc.? Without a doubt, that is a very tall order indeed. But by and large, day in and day out, the vast majority of doctors and nurses in this country do their best every day, and in the exercise of their sound professional judgment, based on years of education and clinical experience, they also do the right thing. There are always however, in medicine as in law and the other professions, the outliers.

One must watch out for the outliers. But how do you do that when you are unconscious and intubated in an operating room having surgery?

In 2011, at a large regional hospital in Torrance, California, Dr. Patrick Yang, a board-certified anesthesiologist with over 20 years of experience, not only forgot why he was in the operating room, he also lapsed into the behavior of a twelve-year-old, and not a very mature one. When the patient, a long time employee of the hospital, was under general anesthesia, he cut out and colored some stickers and then stuck them on the patient, giving her a black mustache and yellow tear drops under her left eye. If that weren’t bad enough, he then permitted a nurse’s aide to take photos of the defiled patient with the aide’s smart phone. (The propriety of smart phones in operating rooms are a subject best left for another day.)

Should we be at all surprised that a lawsuit followed against the anesthesiologist, his medical group practice and the hospital? In his deposition, Dr. Yang said, “I thought she would think this is funny and she would appreciate it.” Did he grow up in a cave and then attend medical school in a galaxy where lame schoolyard pranks are an acceptable expression of scientific prowess?

My anesthesiologist friends have told me more than once that they liken their specialty to that of a long-haul airline pilot — incredible stress at intubation (takeoff) and extubation (landing) that book-end hours and hours of sitting accompanied by undeniable boredom on those occasions when there are (thankfully) no complications (as in flying over the Pacific or Atlantic with a full tank of fuel in clear skies). That may be true, but if one doesn’t want the book-end stress/boredom roller coaster and prefers instead constant stress, then perhaps one might want to consider a different specialty, such as emergency medicine or trauma surgery. Or if one wanted substantially less stress, then perhaps a change to a specialty in dermatology or pathology would make more sense. Or maybe a different profession altogether should be selected.

Engaging in this kind of unprofessional conduct is morally offensive at best and utterly reprehensible at worst. It also flies in the face of some of the very basic tenets of the Hippocratic Oath to do no harm. As in all professions, one bad apple taints the others. Of course thousands of physicians go to work every day and bust their medical chops for their patients, often with little or no fanfare, and very often with reduced insurance reimbursements or payments that are far less than in preceding years, while their expenses and malpractice insurance coverage, of course, have increased exponentially.

The group practice in which Dr. Yang participates suspended him for two weeks, but he remains in good standing at the hospital where the offensive behavior occurred.

Even though I’m a lawyer, I am often the first one in the room to advise against filing suit against someone else. This is so not because I’m a pacifist or afraid of a fight, but because sometimes the price is simply too high and a friend or client’s best interests are often better served in other ways, such as mediation, arbitration, or sometimes by simply walking away from a toxic situation despite the loss. That said, in a case such as this, where the hospital did virtually nothing and the self-policing of the anesthesiologist’s group practice didn’t do all that much, John and Jane Q. Public are best served by this private suit brought by the patient, whose privacy rights were invaded and thoroughly disregarded. And I don’t believe this is lawsuit lottery, as has been suggested by attorneys for the hospital in their motion to dismiss the patient’s case. Sadly, sometimes the only messages people and institutions can truly understand are ones they receive where they can hurt them most — in their wallets.

If this patient litigant is successful in her case, it will hopefully have a chilling effect on a physician possessing the desire to engage in pubescent pranks at the most inappropriate time possible — while a patient is under their care and completely vulnerable and dependent on the physician’s education, experience and sound professional judgment. Here’s hoping.

In Montana in 2008, a 14-year-old girl was raped in a schoolhouse by a 49-year old teacher. At the sentencing phase, the prosecution had asked for a 20-year prison term with 10 years suspended. Last week, Montana District Judge G. Todd Baugh handed down his decision on the sentence: 31-days, with credit for one day served.

No, your eyes did not deceive you there. Judge Baugh gave the rapist a 30-day sentence for the rape of a child not even old enough to possess a learner’s permit to drive her mother’s car. Judge Baugh also said in the same case that the victim was “older than her chronological age” and “as much in control of the situation” as her rapist. Protest organizers have since demanded that the judge resign, and the Montana branch of the National Association for Women and others have called on both the governor and the state’s attorney general to review Judge Baugh’s actions in the case.

I can’t begin to understand what the judge meant when he said that the victim was “older than her chronological age.” She was tall? She looked older? Acted older? Even if all of that were true, under Montana state law (as in many other states), this would be irrelevant, as minors under the age of 16 cannot consent to sex. Thus, what she looked like or how she acted or whether she were six feet tall and still growing by an inch a second can’t be considered; she was legally incapable of consenting to sex. Period.

Let’s assume for the sake of argument that she looked and acted 25. Let’s even go one step farther and say (contrary to all presented evidence) that she wanted to have sex with a man old enough to be her grandfather. Statutory rape laws are ones of strict liability; thus, even if the victim looked 25, said she was 25, acted 25, even provided a fake ID reflecting that false age, and stated plainly that she wanted to have sex with an older man, the man would still be convicted of rape in a state with these laws.

That this case is beyond tragic goes without saying. And it was made even more so by the fact that the rape victim committed suicide in 2010, just short of her 17th birthday. Apparently, she wasn’t “as much in control of the situation” as the judge had previously thought. The only positive aspect of this tragedy is that the rape victim can’t be victimized again by this ongoing travesty of justice.

This, of course, doesn’t even begin to address the more fundamental issue of a teacher’s fiduciary responsibility to his students in a place of learning. The teacher was in a position of trust and authority and he abused that trust horribly in the worst possible way by raping a child in a school house, the one place other than our homes where our children should be safest in an often frightening world.

The fire the protest organizers and the NOW ignited following the sentencing phase must have gotten pretty damned hot in Billings, Montana. This week Judge Baugh has ordered a new sentencing to take place Friday, now saying that Montana state law appears to require a two-year mandatory minimum prison term; he wrote that “imposing a sentence which suspends more than the mandatory minimum would be an illegal sentence.” Ya think??? One would also think that logic, precedent, decency, and accountability might play a role in sentencing statutory rape, too.

Judge Baugh may now not even be able to impose a sentence longer than 30 days, since, under Montana state law, an illegal sentence must be processed as an appeal.

On Tuesday, August 20, 2013, a show I never watch, “Fox & Friends,” aired what has turned into a massive gender-baiting exchange. Fox News medical contributor Dr. David “One Prostate” Samadi, a urologist at Lenox Hill Hospital in New York, argued in the Fox segment that women should pay more than men for health insurance. Why? Because we women have more body parts that need to be checked out. To quote Samadi, “Women have the breasts, they have the ovaries, they have the uterus, they get checked in every part.”

I could say something utterly snide and snarky here, but I am engaging in body-part control.

Samadi’s remarks on Fox so stunned me that I had to sit through the offensive video clip twice just to make sure I wasn’t having an auditory hallucination. Then, in a gender-twisting experiment of my own, as soon as my “one prostate” attorney husband came home from slaying corporate dragons, I had him watch the Fox interview also. My husband (who happened to receive his undergraduate degree from Hofstra University, where Samadi is a professor) was likewise mortified.

I posted the link to the offending interview on my personal Facebook page and that of my book, and tweeted about it as well. I then received messages from several people I did not know, including a Reuters reporter in NY espousing the virtues of Lenox Hill Hospital (with which I happen to agree). Then late Saturday night—actually around 2:00 a.m. New York time—I started receiving Twitter messages from Samadi himself. The first stated that he “was trying to educate men out there to go for screening just like women, not trying to offend anyone.” His second message to me a minute later (in response to the Reuter’s reporter that Lenox Hill is a great hospital) said, “This is not the view of Lenox Hill. I am pointing out that men need to go for screening like women.” In, I imagine, an effort to remove itself from the escalating and damning controversy, the marketing department at Lenox Hill probably told him to clarify that the explosive views he expounded on Fox were solely his own. When I responded to Samadi that his comments were “pure damage control, as he never once mentioned men and screening on Fox,” in that context and that “Lenox must be outraged,” he immediately wrote me (and I am presenting this verbatim) that I should “watch the segment and do not be so judgmental. started by saying that men do not go to doctors like women. Women go for pap smear, mammogram e that is what should do. attacking me will not bring more awareness be smart.”

In an attempt to end this absurd, going-nowhere late-night exchange, I wrote “Sadly for me I have seen it twice. And so has the rest of America. Good night.” He couldn’t control himself, however; he had to have the last word, and wrote, “yes it is sad. It may take you three times to really get the message Didn’t think it was that complex.” Oh, what a guy.

The next morning as I was answering emails, I stumbled upon an unbelievable twist in this saga. One angry viewer of the Fox segment wrote on Samadi’s twitter feed that Samadi is “The most sexist physician in America….Then [if women should pay more for health insurance] women should get paid at least as much as men too, dont’cha think?” Astonishingly (and I am still utterly blown away by his response), Samadi wrote to that viewer on his feed, “Not sexist at all. You mean Sexiest doctor in America. I was actually complementing [sic] women for going for screening unlike men.” What??? Even if he believes he is the sexiest man on Planet Earth, how can this possibly be considered an intellectually honest, or appropriate, response to the Pandora’s Box he so unceremoniously opened?

If you take Samadi’s logic one step farther, should Congress be lobbied to impose a birth tax on women who bear two-ovaried babies, or a double tax on those who have twin girls? How about a tax credit on those who give birth to one-prostate babies? Or perhaps the federal dependent tax credit we Americans currently enjoy should be modified contingent upon the dependent child’s number and/or type of anatomical body parts: two testicles, tax credit; two breasts, tax imposition.

You see where this is going; it’s absurd, unfair, undemocratic, and, frankly, altogether un-American. Given that as of the 2011-12 academic year, women (with ovaries) accounted for 47% of U.S. medical school graduates, my best guess is that none of that nonsense would ever come to pass.

In fairness, people make enormous blunders all the time, even on television, and perhaps especially often on Fox. However, the key is what you do with those blunders after they rear their ugly heads. An honest apology usually suffices, with the requisite mea culpa—or as one of our teenagers (three prostates, one uterus) would say, “My bad.” But such a blatant attempt to engage in ex post facto damage control in such an intellectually dishonest way simply serves to smear the doctor and his name further, irrespective of his technical (urologically speaking) skills. People with such blatantly sexist ideas, regardless of what degrees they hold from prestigious universities, should not be given a television platform from which to disseminate Neanderthalean positions under the disingenuous guise of allegedly educating the public about Obamacare, the healthcare delivery system, and the all-important, holy grail of prophylactic screening.

Perhaps Samadi subscribes to the school of thought that says that any publicity is good publicity. I don’t know about that, although my dual-ovarian instinct says no dice. What I do know however is that Lenox Hill is indeed a very good hospital. I also know that I happen to really like my thus far non-fiscally taxed ovaries. Both of them.

At long last, a Japanese leader has finally figured out a way to boost economic growth in that country and address Japan’s diminishing labor pool. To shore up the country’s numbers, Japanese Prime Minister Shinzo Abe will not be artificially maintaining near-zero loan interest rates, nor will he be “importing” inexpensive labor from nearby Vietnam, Indonesia, or the Philippines. Instead, Mr. Abe has a plan to take advantage of an available resource which Japan has had access to all along, just ready for the taking, but summarily bypassed. He wants Japanese women to participate in the work force in greater numbers.

Japan is, by far, the most developed and modern country in Asia. It enjoys the same 99% literacy rate as the U.S., France and Denmark. It is also extremely ethnically homogenous. Japan is an island nation consisting largely of ethnic Japanese. By design, it is a country to which people very rarely immigrate. Of the approximately 128 million people currently living in Japan, only about two million are expatriates. It is also not a country from which many emigrate; it has one of the lowest emigration rates in the world. Despite high literacy and an excellent and inclusive educational system, however, it is still a very difficult place for women to embrace both a career and a family. This is partially due to age-old concepts of the household and long-standing Confucian ideals regarding family. But it is also due to simple economics — there is almost no affordable childcare in Japan, and corporations simply make it impossible for women to return to work after the birth of their first child.

If all goes according to Prime Minister Abe’s plan, this is about to change, though no doubt it will be a very slow process. Abe’s plan promotes maternity leave, and would increase government-sponsored childcare facilities. In addition, corporations would receive pecuniary incentives to hire more women. All lofty ideals in theory, and even grander in practice.

A further problem, however, is the income differential between Japanese men and women. In 2010, the OECD reported that Japanese women made the equivalent of 71 cents to every Japanese man’s dollar (compared to American women’s 81 cents to their American male counterparts). Japanese men also participate in household activities to a substantially lower degree than their American brethren (which isn’t really all that much if we’re being honest here). Add to this an aging Japanese population in which the vast majority of the burden of elder care falls on Japanese women, and it’s not difficult to see that 24 hours in a day can almost never be enough for the juggling act in which Japanese women would have to engage to complete their tasks.

Although there are many well-educated women who want to return to work after having children to maintain their career paths, the obstacles are many. Thus, despite their desires and abilities, the number of women in high-level positions in government and business is far lower than that of women in other advanced economies.

Prime Minister Abe’s plan is a beginning, made possible by his recognition and acknowledgement of the problem. However, there will need to be other changes in Japan’s domestic law as well if his plan is to succeed. Those would include changes in the tax code, which now penalizes dual income earners, and other wholesale structural changes to promote far more equality than exists currently.

The bigger problem, however, may be a cultural one, for which it is, of course, nearly impossible to legislate any meaningful correction. Japan is, at its very core, a society that abhors conflict in literally all manner of discourse. That is the case in familial, social, and commercial settings. (How else can one explain that there are at least half-a-dozen ways in the Japanese language of saying no, none of which actually means “no,” but all of which are instead indirect variants of something much less than “yes”?) So even though certain corporate conduct in the employment arena is illegal, for example, violations against women employees which in effect prohibit their return to work are rarely reported, since that goes against these very notions of conflict avoidance. This cultural prohibition, coupled with the national allergy to any aspect of discovery or litigation, will render the financial incentives to corporations to hire and maintain women in the work force even more critical to the success of Prime Minister Abe’s plan.

Japan has long been blessed with a highly talented, dedicated, skilled, and hard-working labor pool. However, demographics have shifted so that Japan’s current and future employment needs will not be met as long as the old status quo remains. I applaud Prime Minister Abe’s efforts to start a dialogue about and formulate a plan to tap into this enormous resource of women, which has been present and available all along. The success of his plan, however, will require a cultural shift, domestic law changes, and corporate compliance. With an aging population, diminishing labor pool, and significant gaps in certain market sectors, it will be very tough for Japan to maintain its place in the world economy in their absence. Indeed, a return to the labor force of a significant number of Japanese women would probably not only save its economy but substantially propel it. As any good captain knows, it’s very tough to sail a ship employing only half a mast even in fair weather, no matter how great or sturdy that half mast is. Under somewhat stormy skies, all hands should be on deck.

The U.S. Court of Appeals for the 3rd Circuit has spoken. They have spoken in favor of boobies.

Well, not really. This month, in the “I ♥ Boobies” case, the 3rd Circuit Court of Appeals in Philadelphia decided, in part, that the rubber bracelets two teens wore to school who were then suspended, were only “ambiguously lewd” and not “plainly lewd.” The 3rd Circuit cited Tinker v. Des Moines School District in its decision, an important 1969 U.S. Supreme Court case that involved students protesting the Vietnam War who were suspended for donning black arm bands to school.

Of course the usual and sundry constitutional arguments were raised and argued. Here, as with Tinker, few in a democracy would argue that educational institutions should require students to “shed their constitutional rights to freedom of speech or expression at the school house gate.” That, of course, would be absurd.

The Court in the I ♥ Boobies case came to the correct decision from a constitutional law standpoint. Of course the 3rd Circuit was not really concerned with boobies or breast cancer, nor should it be. But if the I ♥ Boobies case brings even a scintilla more publicity where it should be directed–to the issue of breast cancer awareness for John and Jane Q. Public and their elected officials who can try to squeeze some more funds out of Congress for more breast cancer research–then hail to the 3rd Circuit, I say.

The fact that these two middle-school girls were even conscious enough of the subject in the first place to wear those rubber bracelets to school reflects just how far the fight against breast cancer has come in this country in the last two decades. Heck, I recall when you couldn’t even say the word “breast” at a dinner or cocktail party–unless of course you were referring to the main course. My, my how times have changed. So now that we have some of the best and brightest black-robed constitutional jurists speaking and writing lengthy published opinions about boobies, perhaps we can get the suits inside the beltway to figure out how to cough up some more money for research and bring us closer to a day when, as one of my dearest friends remarks every time before he commences yet another Komen 3-day, 60 mile walk for the cure, “the beast can be slain.” Once and for all. Here’s hoping. Walk on.

I am an incredibly lucky traveler in that, despite having traveled to sixty countries, I have never really gotten sick. Perhaps I should rephrase that. I have had the occasional stomach upset while tasting street vendor delicacies in Indonesia, and I once got food poisoning from some bad fruit juice in the former Yugoslavia. And one time I got a fairly nasty exhaust pipe burn on my calf from a rickety old motorcycle I was stupidly riding somewhere up in the hills of Northern Thailand. But nothing more serious than that, and nothing that required a trip to a hospital or even to a clinic — that loud sound you hear is me knocking profusely against the wood desk at which I am sitting.

I was in-house counsel to a surgical facility for several years, and often inadvertently saw plenty of surgical detritus; my brother is a doctor, and my mother’s second career was nursing. To even my surprise, however, I don’t think much about healthcare while traveling overseas. Perhaps it’s blind luck, or perhaps it’s simply magical thinking.

Last month, seven years after my first visit to Vietnam and Cambodia with my then ten-year-old daughter, I took my husband to Vietnam. We started the trip in chaotic Saigon in the south, and traversed the beautiful coast in Nha Trang and the sleepy island of Ninh Van. Then, following the hustle and bustle of Hanoi in the north, we ended up 400 kilometers to the very northwest of the country in the hills of Sa Pa, not far from the Chinese border. The good news is that we had a great time. And no, other than one nasty spider bite of unknown origin on an overnight boat junket in the World Heritage Site of Ha Long Bay in the east of the country at the very end of the trip, no one got sick. The bad news is that we learned that one never, ever wants to get sick anywhere in Vietnam.

There has been incredible economic progress in many sectors of Vietnam since its doors opened to foreign travelers in the mid-1990’s. One sees everywhere the ready appearance of Communism “light,” at least from a market standpoint: business is simply booming and construction in rampant. However, one sector in Vietnam which is far, far behind even that of other emerging nations is its healthcare delivery system.

In a country of approximately 91 million people, as of the end of 2012, there were only 1.2 physicians per 1,000 inhabitants; this reflects virtually no increase since 2008. For comparison purposes, Greece has 6.2 physicians per 1,000 people, and the U.S. 2.4 per 1,000. In several state-built and state-run “hospitals” in Vietnam, especially in the more remote northern regions of the country, there simply are no doctors at all, not even visiting doctors, just a few nurses to tend to a wide variety of the population’s ailments. And in the bigger city hospitals in Saigon and Hanoi, there are precious few nurses as well. But that, of course, is only one part of the problem. Another, perhaps potentially more systemic problem is the rationing of services to those best able to pay bribes to physicians and their staff. One should keep in mind that the average public school teacher (and teaching is considered by many to be a good job) makes the equivalent of $150 per month. Indeed, Vietnam’s GNI for 2012 was the equivalent of $1,400. Many working people, especially those who work for large companies, have state health insurance, at least in theory; in reality, however, it may not provide them with care, or at least not with care that is acceptable.

We know a Vietnamese couple who live in Hanoi, both of whom work in tourism. The wife works for a large French hotel chain which provides her with health insurance. When she was about to have their first child, she learned it would be necessary to schedule a Caesarian section. Had she gone to the public hospital for the delivery, she would have had to share a hospital bed with another female patient, and that bed would have been in an unbelievably overcrowded ward. She would have also had to bring several family members to tend to her pre- and post-operatively around the clock, because of the severe nursing shortage. Those family members would not have been given so much as a chair, but would instead have to sleep under the patient’s bed on the floor, usually on a straw mat which they would likewise have to tote along. They would have also been required to bring supplies, including food, water, and other items for the patient. So instead, our friend took his wife to a private hospital where he paid bakshish in an amount equivalent to $300 to the physician (paid in cash in secretly following the successful birth). An additional $200 went to the hospital for use of the operating room and medicines, and $80 went to the semi-private room at $20 per day. Following the birth, our friend was subsequently reimbursed the sum of $25.00 by his wife’s insurer. This was, ostensibly, the amount that would have been paid directly to the public hospital had the delivery occurred there. A friend of the couple had a child two months ago at the same private hospital with the same physician, but this was a normal vaginal delivery. The bakshish to the doctor in that case was “only” $150. However, the friend’s infant was born with a lung infection which required anti-biotics, costing an extra $300, and requiring a three-night stay, for an additional $60.

While the numbers are, of course, minimal by U.S. healthcare cost standards, they are shocking when viewed in light of the average Vietnamese person’s annual income. Clearly there is nothing in a U.S. hospital that costs $20, except perhaps the daily parking charges. However, I have certainly received a reimbursement check from an insurance company in the U.S. for $25, though I think the submitted charges were something like $500 — or perhaps it was $5,000.

In case this story seems hard to believe, take a gander at the photos below, all of which were taken at Bach Mai hospital in Hanoi. Here you see the line to get in to the hospital, a photo of the corridors, and one taken of the wards.

So if you are heading east, pack along a good first aid kit, travel safe, and take a pass on the ever-present motorcycle taxi should you find yourself in Vietnam. And the next time you think to complain about health care delivery in the U.S. in general, or Obamacare in particular — and if you do, you will need to get line right behind me — you may want to take a look at these photos again. Then thank your lucky stars that our health care is as “awful” as it is.

Some of you may recall that back in 2008, a New Jersey man made headlines when he made a ruckus about a bakery that refused to frost his son’s birthday cake with his name–which just happened to be Adolf Hitler Campbell. (One of Adolf Campbell’s sisters was named Joyce Lynn Aryan Nation Campbell.) Mr. Campbell was in the news again thereafter when his fourth wife got pregnant and they publicly discussed naming their unborn child Eva Braun. Clearly, there was a familial theme going on there in New Jersey.

All of these given names are, of course, perfectly legal. Their legality, perfect or imperfect, does not mean that it does not require herculean strength not to vomit up yesterday’s dinner at the thought of those morally bereft moniker selections. Not to mention the enormous parental curse with which one can endow one’s offspring in engaging in such naming practices. When parents do something seriously lame, regardless of context, one often hears the silly though often pertinent joke circulate that “a license is required by the state to drive a car, but not to have children.” But I digress.

In Tennessee last week, during a family court proceeding to determine paternity and child support for a toddler named Messiah, the child’s unwed parents also fought over his last name. The magistrate, in an act which can only be described as demonstrating unmitigated chutzpah, also decided to change Messiah’s first name to Martin. In doing so, the bench officer cited the often overused “best interests of the child” catch-all phrase for judicial imposition, arguing that since Cocke County, Tennessee has “a large Christian population . . . it is highly likely that he [the child] will offend many citizens . . . .”

Frankly, is the name Messiah any different from naming a child Moses, Mohammad, or Jesus? All of those are fairly common given names in today’s religious melting pot. But really, that’s beside the point. The point is that if a society’s culture can be viewed as a house (or, for that matter, a condominium or apartment), then language is the key to opening the front door. The question is, who gets to decide which language is acceptable? It is our duty as members of a sane society to open and have the conversation about the correctness of such names, and ultimately to judge people like Mr. Campbell, and to a certain extent, perhaps, the parents of baby Messiah. But society’s ability to judge a person’s character content or religious choices does not have legal repercussions, nor should it. Ever. Those decisions can never be made by judicial fiat determined in a court of law under color of it. Not only are courts not the place for religious promotion, they are also not the place for proselytization, religious dogma, or persuasion. It’s one thing for courthouses to have “One nation under God” plastered on their walls and even to use Christian Bibles to swear witnesses in before they take the stand to give testimony. It is, however, something else altogether for a judicial officer to say with regard to your offspring’s first name, “It’s my way or I’m changing the highway.”

As I come from a family some of whose members were Holocaust survivors, no doubt I would have very serious issues if I went, for example, to a school function and were introduced to the Campbell family by their given names. But that’s me, and I would simply have to deal with it. However, bumping into Jesus at Home Depot, Moses at the Israeli market I go to, or Mohammad at the local Lebanese restaurant bothers me not at all. But that too is me, since I am not religious. The key is that this is what rational, thinking people do: they decide for themselves what they can tolerate and what they cannot, and then adjust their universe accordingly in keeping with those sensibilities. God help us all if instead those choices fall into the hands of our courts of law to decide.

When I heard late last month that President Obama had announced his nomination of former first daughter Caroline Kennedy as U.S. Ambassador to Japan, I remember thinking “Really?”

I have absolutely nothing against Ms. Kennedy, a fellow attorney, talented writer, and of course, daughter of Camelot, who is by all accounts, smart, dedicated, and an incredible fundraiser. However, as someone who has lived in Japan, and who has studied the language and culture, I am left scratching my head as to Obama’s choice for such a vitally important posting.

I understand of course the politics of these appointments. After all, Ms. Kennedy was instrumental in propelling Obama to the 2008 Democratic nomination, and in the 2012 race, served as one of 35 national co-chairs of his re-election campaign. That said, I’m thinking the more appropriate ambassadorial post for her would be something along the lines of, say, Belize, or perhaps, Bermuda. Or like her aunt Jean Kennedy Smith, to Ireland.

If Kennedy is confirmed, she would be the first woman in this post to a fellow G-8 nation. That of course is not in and of itself telling. Although Japan has a history of being quite slow to accept women in professional capacities, that stance is shifting, little by little. And besides, Japan holds gaijin in general, and gaijin women in particular, to a different standard than that of Japanese women. But the real issue is that Japan is one of America’s most important international partners, both commercially and militarily. To have someone at this level of posting with virtually no Japan experience, and about the same amount of foreign policy experience, is, well, just plain silly. This is especially so given that there is an abundance of professionals with far more foreign policy experience and with real and close connections to Japan that would make them far more effective in the Asian arena. Granted, they may not have the political panache or the household name recognition of the Kennedy clan. But from an economic and military standpoint, especially given North Korean nuclear capabilities and continuing disputes with China, do we really care?

As many Japan experts will agree, it is a wonderful country, but it is also a very complex one, historically, socially, culturally, and linguistically. And it takes a long time and a significant commitment to understand its ways and to be successful there professionally and personally. In my opinion, it is insufficient, as some have suggested, that Kennedy will overcome her significant deficiencies in foreign policy, language, and cultural connection by having an experienced staff and a Japan expert shadow aide her while she is ambassador. It is also offensive to me that Kennedy’s celebrity appeal, close relationship with Obama, and her gender have been argued as her main selling points for this position. This is form over substance at a time and in a place with no room for that.

Those selling points may be just fine for an ambassadorial post in Belize, but not for an envoy as important as one to the land of the rising sun, which also happens to be our greatest and strongest ally in Asia. Really.

I first went to Vietnam in 2006 with my then ten-year-old daughter in tow. As part of nearly a month traveling in the country we spent several days far up north near the Chinese border. Nine hours by train northwest of Hanoi to be exact. The over night train from Hanoi arrives in the small, but bustling and fairly charmless town of Lao Cai. It is in Lao Cai, not far from the main train station, where the tall, white “border bridge” with China can be seen from several points in the town. From Lao Cai it’s another 90 minute drive up a two-lane mountain road where you get to view some of the greenest terraced rice paddies in Asia. As the trees get denser and more green, and the road more mountainous, you arrive at the town of Sa Pa, dubbed by the French in the late 1800’s the “Switzerland of Asia” for its terrain and its temperate climate in a region where the normal lowland summer humidity is equal to or higher than its temperature. (The name Sa Pa derived from the French word sapin — fir tree — owing to their abundance in the area.)

During our 2006 trip, as I recounted in my book Fifty-Fifty, The Clarity of Hindsight, one of our most memorable experiences was a trek we took with a group of women from one of the Hill Tribes. Up, up, up we traveled along their mountain path, over the rice paddies, around the wild boars and working oxen and the nearby waterfalls to their villages. We were invited into their homes with a generosity unknown in western civilization, where we saw life pretty much the same as it had been for the previous 300 years. Stilt houses with grains and foodstuffs stored in second-story lofts, sleeping, working, and eating areas on the bottom floor with an open fire pit for warmth in the winters and cooking year-’round. There was then no electricity, and no running water.

Even in 2006, the Hill Tribe women made their way down the mountain daily to Sa Pa to sell their wares — mostly woven items, such as tote bags and satchels and filigree earrings, bracelets and necklaces. These are beautiful, petite women possessing an amazing physical strength, who all bore children very young and who appear many years older than their stated ages.

This summer’s trip to Sa Pa started out pretty much the same, except that my travel partner this time was my husband: the same overnight train, the same drive up the mountain; we even stayed at the same mountain lodge on a hill overlooking the town. And we planned on taking a similar trek to visit the Hill Tribe women. In addition to English, our accompanying Vietnamese guide also spoke two of the Hill Tribe dialects, H’Mong and Tay, which came in very handy, since in one of the Hill Tribe homes we passed along the mountain trail the woman only spoke H’Mong. She was so happy to see us trekking by that she invited us into her home, showed us one of the beautiful garments she was working on, made from woven hemp dyed with indigo, and offered us rice cakes and mountain apples. This lovely woman toiling alone in her humble abode with a 50,000 kilowatt smile was charming beyond measure and seemingly possessed a contentment some of us westerners could only dream about.

As the days progressed, we passed through several other villages, were invited into many other homes, and met several other families, dozens of children, and countless ducks, hogs, piglets, horses, dogs and oxen. Despite the intervening seven years since my first trip there, and the still very primitive nature of their lives, I was nevertheless shocked to notice that in many of the huts there is now electricity — albeit often only a single light bulb — a few of the huts had television with some jerry-rigged electrical/cable wiring which appeared ready to implode, and, I had heard, a couple of the huts had wifi.

Down the mountain in Sa Pa, many of the young Hill Tribe women still sell their wares along the sides of the roads, but because of their excellent English skills, they are now getting work as tour guides to lead treks to their villages. (Their unaccented English is superior in large part because it is learned not in a classroom from native Vietnamese teachers, but by communing with native English speakers who tour the region.) There is also massive construction of new hotels in Sa Pa. In the center of the town itself used to be the main produce market, but it also contained the “Love Market” which acted as the Saturday night social locale for the young Hill Tribe people to find mates — the equivalent of the church social, but without any religious component. On this latest visit, I found that the entire area of the town center was boarded off and one couldn’t tell what was actually being constructed there, although work was clearly taking place. My numerous inquiries never really gleaned a concise answer, though I was told by various people, in sum, that the town was building an oxymoronic-sounding concrete parkway for a new market. Across the street from the old Love Market sits the small yet regal and perfectly proportioned Catholic Church, which now boasted enormous neon lights strung along the outside that changed glaring colors every few seconds, similar to nighttime at LAX.

As our days in the region came to a close, I commented to my husband that I was so glad I’d had the chance to see the region in 2006, just a few years after the country had opened up to foreign travelers, and hence was able to see it in its most pure and authentic form. As this was my husband’s first trip to the region, he was still in visible awe of what he was able to see. An hour later, when I went to reception to check out of the lodge, I reflected to the clerk about the amount of change in Sa Pa in the last few years, to which he replied, “Good you came back now, as in twenty years, Hill Tribe life will be gone and there will be nothing left to see.” The winds of change. The signs of progress. Sigh.

On Saturday, July 27, 2013, Julie spoke at a day-long seminar held at the University of West Los Angeles School of Law. Sponsored by several attorney associations and many other professional groups, the seminar was entitled “Piercing the Veil of Culture: Cultural Competency in Family Practice,” and Julie spoke on “Getting Married in Israel and Japan.” This well-attended event included attorneys, judges, commissioners and mental health professionals from all over the state of California.

About a week ago I received a long email from a woman in her mid 20’s who was traveling in Europe and who came across Fifty-Fifty at the venerable and old Shakespeare & Company bookstore on the left bank in Paris. In part, the reader wrote:

“I just wanted to let you know that I really enjoyed your book, and that it was so fitting for me to read as I finally begin to close off my travels being in Europe for the first time and the first time being away from home for so long. I hope that like you, I can travel much more and see more of the world, meet amazing people and learn more about myself and be able to encapsulate all those lessons learned in writing. I particularly loved your story of your friend Sophie from Paris. I think that in life, being able to influence those around you in a positive way just by the way you live is perhaps the greatest blessing you can endow on someone. Thank you so much for sharing your experiences and words of wisdom that I can replay in my mind as I prepare to go back home with all of my own new experiences and new found wisdom.”

While it is always wonderful to hear from readers who have enjoyed your work, receiving that note was particularly meaningful to me. First, due to the serendipitous nature of how she got the book. She had been working in Marseille for six months and was invited to Paris overnight and stayed with another young woman who showed her Shakespeare & Company. She went in but didn’t find anything of interest to buy. That evening (which was a few days after The 2013 Paris Book Festival awards dinner) and the night before I was to return to the U.S., I stopped by Shakespeare & Company and dropped off one copy of Fifty-Fifty for their lending library. Fifty-Fifty inadvertently was then mis-shelved. The next day on her way to the train station the woman again returned to Shakespeare & Company hoping to find a book to take with her on her last month of European travels. She then found Fifty-Fifty on the same shelf she had scoured the day before and purchased it. Second, when I wrote Fifty-Fifty I really had the over 40’s crowd in mind as a readership demographic. That someone in her mid-twenties was so moved by the book and took the time to write of its impact simply made my day.

A wise woman once said there simply are no coincidences. I would have to agree. I was meant to drop Fifty-Fifty off there on Sunday even though it would have been easier to ship it when I returned, Fifty-Fifty was meant to get on the shelf for sale instead of the lending library which I’m told rarely happens, and the young woman was meant to return there Monday to find it en route to meet her friends at the train station and journey onward.

Having spent a great deal of time in Asia, and in Hong Kong in particular, I was extremely suspect of Edward Snowden having gone to Hong Kong even before many of “the facts” of the matter were revealed. That said, what continues to fry my goose the most in this case is the concept that a foolish young man can decide, because of some tech-savvy, to become an unelected Attorney General and pose significant risks to our national security under the guise of some highly distorted sense of patriotism.

There’s a huge problem with so many in his age group considering they are cyber-citizens at the expense of claiming citizenship in the physical world. Chief among them is that there are precious few laws in place or which can be enforced that provide protection for breaches of laws we have come to rely on and to respect, as is the case for example with copyright law. And here I speak from personal experience; my book Fifty-Fifty, The Clarity of Hindsight is registered of course under U.S. copyright laws and was released by my publisher in September 2012 in print and in November 2012 in E-format. It was recently pirated and made available on-line through a Chinese hosted web site. Until that is the U.S. credit card company processing payments for the Chinese infringer was threatened with contributory infringement. The Chinese site remains up complete with the cover of my book, but the infringed material can no longer be downloaded and paid for by credit card, at least not in the U.S. While perhaps no national security issues are affected by breaches of copyright laws, the possibilities for damage on other avenues are nearly endless. And on this point Snowden and others of his ilk represents a far more complicated challenge. To national security and otherwise.

I learned last week that the rights to Fifty-Fifty, The Clarity of Hindsight were purchased by LW Digital in Korea, Gardners in the UK, eSentral in Malaysia, and HyRead and BIG in Taiwan. The world is getting smaller indeed!!!

While in Hawaii last month for the 2013 Hawaii Book Festival, I bore witness to a visual scene not often played out in my Hawaiian homeland. At the end of the first day of the Festival, my husband and I were relaxing by the beach in East Honolulu. Glass of wine in hand, we were just in time for sunset. About thirty feet to our left were three women covered head-to-toe in black abayas. The three women were approaching the water and entered, full abayas and all, until they were submerged to their chests. Near them, with facial hair that is trademark to a devout Muslim male, was, I presumed, one of their husbands. Or perhaps the husband to all three women. He was wearing traditional Hawaiian board shorts.

It was a day that had two torrential downpours and flash flood warnings on the South shore, and all I could think of that moment was that I hoped these women didn’t drown in their abayas with the pull of the Pacific. I had seen a group of head-to-toe abaya clad women swimming in the ocean before in Malaysia and though it was a stunning sight then, it was a tad less shocking, as Malaysia is, of course, a Muslim country. That said, the abaya clad women I saw swimming in Malaysia – also with one lone male in tow – were tourists; probably from Saudi Arabia, as Malaysia is a fairly common tourist destination for the nearby Arab countries.

I kept my eyes on these women, continuously counting to assure all three heads were above water. I then made a comment to my husband about the seeming unfairness of wearing that much clothing in the ocean. However, I quickly noticed that he was not paying attention as he was very busy making goo goo eyes to an utterly adorable toddler wearing the silliest possible hat and who was being held over her mother’s shoulder at the next table. It was at that precise moment that I overheard the toddler’s parent’s conversation: they were speaking in Hebrew, the native tongue of my mother.

It was one of those moments in life when you instinctively rub your eyes and pull at your ears as the scene before you just doesn’t seem to fit. Here I was sitting at a beach bar in East Honolulu, not far from where I passed many years of my youth, filled with Asians and Polynesians of every possible type and combination, watching this middle-eastern microcosm play out before my very eyes. It reminded me of the time I was ordering dinner in a Chinese restaurant in a trendy part of Tel-Aviv and the Chinese waiter spoke perfect Hebrew. Something akin to ‘what is wrong with this picture?’ On this little beach in East Honolulu, the Israeli family and the Arab one were not within ear shot of each other, though it was doubtful the Israeli couple could have missed seeing the Arab women’s abayas as they meandered back and forth in the nearby surf. Perhaps the Israelis didn’t give it a second thought; they can certainly see various levels of abaya clad women at several Israeli beaches. For me however, it was proof positive just how small our world has become since I started traveling the globe in 1973. While I somewhat irrationally wanted the abaya clad women to shed their onerous black sheaths so they could fully enjoy the splendors of the warm and blue Pacific, I was nevertheless thrilled to see my little Hawaiian island play a role, no matter how small or how insignificant, in a mini United Nations, Hawaiian island style.

The 2013 Paris Book Festival was last week and was a wonderful event. In attendance were author winners from Japan, Croatia, South Africa and the US to name a few. The awards dinner, held at Le Square Trousseau, had great wine and great food and was salon style, like in the days of old Paris. All that was needed was Gertrude or Anais to make an appearance to make it complete! It was a terrific evening with some heartfelt speeches. Merci mille fois!

The 2013 Paris Book Festival awards gala is this week. Fifty-Fifty, The Clarity of Hindsight was first runner-up winner in its category! Heading to Paris this afternoon for what should be quite a literary event. A bientot.